HomeMy WebLinkAboutBuilding Permit Applicaiton ,
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��V{{�
Dater tH J Permit Number: �' 0 7)(1,
1?E'C
01.1x4 " - Erv'-
MAR
Building Permit Applicatiogrm;ttn 4 20»
BPlanning and Development Services uilding and Code Regulation Division St' Luc.e county ent
2300 Virginia Avenue,Fort Pierce FL 34982
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: 3gw; se Mice"-z UA c_/, P5z._, F 3 Yq5
Legal Description: tAQ_4-sP—e c,,j, �f¢ 3 L.-ru 8Lit c(---7 Io f .0
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Property Tax ID#: 3`i`c LS 700-D( 3 S r coo--6 Lot No. 4:,
Site Plan Name: Block No. S 7
Project Name:
Setbacks Front Back: Right Side: Left Side:
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••itiona wor to •e pe Orme• un•er t is permit–c ec a t at app y: 1
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric —Plumbing _Sprinklers —Generator oof 137 fc Pitch
Total Sq. Ft of Construction: c2 0 0 Sq. Ft.of First Floor:
Cost of Construction:$ ((fl_S00 v 00 Utilities: Sewer Septic Building Height: I .571‘
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Name i=:'�: `=, . �. i Name: �-- 4 e
Address: 3 q aS S'E ? 4'c Ne4e.Company: X145 . --e-4.43t .2e
City: 05f,..._, State: _Address:) ib ,. . OT
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Zip Code: 3 9`SAFax: City: (-�o _ gr-e-40� State:
Phone No. Zip Code: 3 3i 7s Fax:
E-Mail: , Phone NQ 7 7rn- S- 3 S'�ori'��
Fill in fee simple Title Holder on next page(if different E-Mail J 1.4k c CEJ5Sgc nq , Ce-rA(✓
from the Owner listed above) State or County License C.CC_O.5T 6 7 3?
If value of construction is 25001or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
_ —
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Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
I
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.1
In consideration of the granting of this requested permit, I do hereby agree that 1 will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording your No ice of Commencement.
, -
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Signature Owner/Lessee/Contracto -Agent for Owner Signature of Co ractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF /HA Artf-11-74._ COUNTY OF /"Ki5l-94-1
The foraqing instrument was acknowledged before me The forgoing instrument was acknowledged before me
t
this riday of merti, ,2047 by this j__Iietty of ,41}:2-,--e_.4 ,20 I'?by
414,6_e_ Coi,y5 x 1 ---- it' Zi.76e Gy"--j-
1,__
(Name of person acknowled:-.• ) . (Name of person acknowledging)
?C•••• jarr"--,...) ". / 't Czp,-,,e, 7 , OD
$ . 61114 C.Vv&-"
(Signe e of Notary Public-State of Florida) (Signa • of Notary Public-State of Florida)
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Pers fly Known (.7 OR Produced Identification Per « . ly Known ,---- OR Produced Identification
Type of Identification - Ty«- if Identification .
Produced Producad - -
Commission No. I q 6514 (Seal) Commission No, I,tab tq (Seal)
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REVIEWS FRONT i ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014
•
/4.."....'i............. . NotajryPublic-DAVIDState
U
JUSTIN DAVID CONI ,
!4?tant.(ti Notary Public-State of NOritta "'" STltslCOorNfElorida
i . 11Commission#GG 196519
Mc':
\ fvo.• My Comm.Expires Mar 1',
''''IL'.Bonded through National Notary Assn.
''''''through National Notary AM,
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